Menopausal Disorders Research Articles

Cardiovascular risk markers in women with metabolic syndrome at the menopausal transition using multimodal non-drug therapies

Aim. To study the effect of non-drug strategies on the main markers of cardiovascular risk in women with menopausal disorders and metabolic syndrome (MS).Material and methods. Three hundred women aged 45-50 years with disorders during the menopausal transition and MS were ranked in 5 groups. In group I, following methods were used: standard treatment, physiotherapy, balneotherapy, multivitamins and minerals, as well as physical factors (vibration therapy, chromotherapy, melotherapy, aromatherapy, aeroionotherapy). In group II, chromotherapy was excluded from the above methods, in group III — vibration therapy, in group IV, physiotherapy was not used, in group V only standard treatment was used. We assessed blood pressure (BP), lipid profile, levels of glucose and serum insulin, and estimated the HOMA-IR index (Homeostasis Model Assessment — Insulin Resistance).Results. Complex treatment using physical factors contributed to the optimization of BP control, improved carbohydrate and fat metabolism. The simultaneous use of all the above physical factors made it possible to improve BP control and most significantly reduce after 6 months of therapy in patients with mild climacteric syndrome the HOMAIR index by 56,2% and the atherogenic index by 31,2%, and in patients with moderate climacteric syndrome — by 57,2% and 30,5%, respectively (p< 0,0001). The decrease in the Green test was 55,3% and 39,9%, respectively (p<0,0001).Conclusion. Non-drug strategies with physiotherapy help to reduce the manifestation of cardiovascular risk in women with MS at the menopausal transition, positively affecting modifiable factors and normalizing the activity of hypothalamicpituitary-gonadal axis. The priority is the simultaneous use of vibration therapy, chromotherapy, melotherapy, aromatherapy and aeroionotherapy.

Menopause: focus on additional therapy opportunities. Literature review

About 10% of the world's populations are menopausal women. This period coincides with the most active social and professional activities of almost every woman. In addition to typical manifestations, this age stage is characterized by menopausal metabolic syndrome, which is caused by estrogen deficiency and is found in 35–49% of women in older age groups.Modern approaches to the treatment and prevention of menopausal disorders include following principles: lifestyle changes, menopausal hormone therapy (MHT), non-hormonal therapy (drugs with hormone-like effects, phytoestrogens, selective modulators of estrogen receptors, β-alanine, sedatives, tranquilizers, and antidepressants), non-drug correction methods.According to the International Menopause Society recommendations (2016), MHT is a gold standard for prevention and treatment of menopausal disorders. However, the choice of MHT as a therapeutic standard is not always unambiguous and acceptable, because hormone therapy is associated with a number of side effects. In addition, there are a number of absolute contraindications for MHT. Therefore, the task of a gynecologist is to choose personalized (individual) therapy for menopausal disorders for each patient. Factors that must be considered when choosing between MHT and non-hormonal drugs include: severity and duration of menopause syndrome, presence of absolute and relative contraindications for MHT, patient’s desire, tolerance of the chosen method.Phytoestrogens (selective modulators of plant-derived estrogen receptors, which are structurally similar to endogenous estrogens) are well-researched among the means of non-hormonal therapy of menopausal patients. Due to their weak estrogenic action, they reduce the severity of menopausal syndrome without affecting the proliferative processes in the endometrium. Phytoestrogens are used by gynecologists in many countries for mild climacteric complaints and/or if there are absolute contraindications for MHT. One of these drugs is Climona® that is contains biologically active components of plant origin (hop cones, cimicifuga root, dioscorea root, vitamin D, α-lipoic acid), which have been shown to be effective in decrease of menopause manifestations and reducing menopausal metabolic syndrome

Преимущества фиксированных комбинаций для терапии артериальной гипертензии у женщин с менопаузальными расстройствами: фокус на Гипотэф

Преимущества фиксированных комбинаций для терапии артериальной гипертензии у женщин с менопаузальными расстройствами: фокус на Гипотэф

Resolution of the I International forum of experts in menopause

On November 8–9, 2019 in Tbilisi (Georgia) the I International Forum of Menopause Experts initiated by the Association of Gynecologists-Endocrinologists of Ukraine was held. Expert working group included leading specialists in the field of obstetrics and gynecology in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Uzbekistan and Ukraine. Experts presented data of their countries on the status of menopause management, experience in solving problems of this period of life.During medical counseling women should pay special attention to the timely start of therapy, explaining the benefits and risks of menopausal hormone therapy (MHT), identifying age-dependent risks and ways to overcome them. MHT is the most effective and pathogenetically substantiated method for the correction of menopausal disorders today. The goal of MHT is to partially compensate for the deficiency of sex hormones using minimally optimal doses that can improve the general condition of women and ensure the prevention of late metabolic disorders and osteoporosis.Individualization of MHT depends on the patient's age and menopausal status. For each stage of woman's reproductive aging according to the STRAW+10 a balanced decision is required on the choice of the regimen and dosage of the combined MHT with therapeutically effective low-dosage forms. It is recommended to start MHT mainly in perimenopause or in early postmenopause, but with menopause duration no more than 10 years. It is necessary to evaluate the thickness of the endometrium using transvaginal sonography before therapy.In perimenopause it is preferable to start MHT in a combined cyclic regimen with a lower dose of estrogen. In postmenopausal women it is preferable to start with a lower dose of estrogen and use a continuous combined dosage regimen of estrogen and gestagen. It is proposed a continuous assessment of the fractures risks to effectively prevent the osteoporosis in women in the postmenopausal period.An annual basic examination is necessary throughout the entire period of MHT use: measurement of weight, waist circumference and blood pressure level, gynecological examination, cytological examination of a cervical smear according to Papanicolaou, ultrasound of the pelvic organs with determination of the endometrium thickness and structure, mammography.

Menopause. A problem that is not out of date. Specialist comment and updated data from the National Consensus on the Management of Patients in Menopause

Climacteric is a physiological transition period in a woman’s life during which the reproductive system involutive processes against the age-related changes are dominated in the body, and characterized by reduction of menstrual and generative function due to genetically programmed cessation of ovarian function.There are 4 periods of menopause: menopausal transition period, menopause, perimenopause and menopause.This document provides an overview of existing diagnosis and treatment methods of menopausal disorders in women, proposed algorithms for diagnosis and treatment of this disease to prevent heart diseases, osteoporosis and improve the quality of ukrainian women life.No need for hormonal laboratory research to diagnosis of perimenopause and menopause for most healthy women aged over 45 with the following features: vasomotor symptoms on a background of irregular menstruation in perimenopause; absence of menstruation for the last 12 months or appearance of menopausal symptoms after hysterectomy at menopause.The most common symptoms of menopause are vasomotor symptoms (hot flashes, night sweats, palpitations, labile blood pressure); psychological (emotional lability, depression, anxiety, irritability, sleep disturbances, poor memory and concentration); general physical symptoms (asthenia, headache, pain in muscles and joints, skin discomfort); urogenital and sexual (vaginal itching, burning, dryness and dyspareunia, frequent and urgent urination, decreased libido).The only pathogenetically effective method for the correction of menopausal disorders is menopausal hormone therapy. For this therapy are used natural estrogen (17β-estradiol, estradiol valerate, estriol) in combination with progestins (dydrogesterone) or androgens. It is possible parenteral (injections), transdermal, vaginal and oral hormone introduction.To correct the climacteric syndrome, urogenital disorders are used short courses of menopausal hormone therapy (for 1–5 years). For the prevention and treatment of osteoporosis menopausal hormone therapy lasts over 3 years if necessary, in combination with a bisphosphonate.

Avocado-Soybean Unsaponifiables: A Panoply of Potentialities to Be Exploited.

Avocado and soybean unsaponifiables (ASU) constitute vegetable extracts made from fruits and seeds of avocado and soybean oil. Characterized by its potent anti-inflammatory effects, this ASU mixture is recommended to act as an adjuvant treatment for osteoarthritic pain and slow-acting symptomatic treatment of hip and knee osteoarthritis; autoimmune diseases; diffuse scleroderma and scleroderma-like states (e.g., morphea, sclerodactyly, scleroderma in bands). Besides, it was reported that it can improve the mood and quality of life of postmenopausal women in reducing menopause-related symptoms. This article aims to summarize the studies on biological effects of the avocado–soybean unsaponifiable, its chemical composition, pharmacotherapy as well as applications in autoimmune, osteoarticular and menopausal disorders. Finally, we will also discuss on its safety, toxicological and regulatory practices.

Эстрогенный компонент в профилактической стратегии менопаузальной гормональной терапии

Objective of the Review: To discuss clinical and experimental research data, focused on some non-reproductive effects of estrogens and the role of menopausal hormone therapy (MHT) in ensuring women’s health during aging and preventing age-associated diseases. Key Points: Combination oral MHT is most effective in preventing cardiovascular diseases, metabolic syndrome, and diabetes mellitus, when initiated during the menopause transition. Individually tailored regimens containing the bioidentical estrogen 17β-estradiol and dydrogesterone, a metabolically neutral gestagen, ensure highly safe MHT. Conclusion: Professional medical communities currently have no doubt about the need for early initiation of MHT, taking into account all indications and contraindications, for arresting menopausal disorders and prevention of metabolic and neurodegenerative conditions. Keywords: menopause, combination hormone therapy, cardiovascular diseases, neurodegenerative conditions, metabolic syndrome.

Альтернативные (негормональные) методы лечения менопаузальных расстройств. В помощь врачу-интернисту

Climacteric syndrome (CS) is a pathological condition that occurs in a significant part of women in the menopause. Menopausal hormone therapy (MHT) is recognized as the most effective treatment for menopausal disorders. However, in real clinical practice, not all women in the transition due to various reasons can use MHT. Alternative (non-hormonal) treatment methods can be used to alleviate the symptoms of CS. The article describes the main alternative methods of treating CS. It is indicated that a positive effect of these methods on the course of CS to a certain extent may be associated with the placebo effect.

Current antimicrobial therapy of infectious complications of genitourinary syndrome in perimenopausal women

Genitourinary menopausal syndrome is characterized by urogenital and sexual symptoms (vaginal dryness and itching, urinary incontinence, dyspareunia, anorgasmia). According to many experts, the symptoms of genitourinary menopausal syndrome require special attention, since women are often silent and do not complain about its manifestations.Purpose of the study. Treatment optimization of vulvar and vaginal atrophic changes that associated with estrogen deficiency in perimenopausal women.Materials and methods. 41 women with infectious complications of genitourinary menopausal syndrome were examined and treated. The structure of this syndrome in examined women was dominated by symptoms of vulvovaginal atrophy (itching, burning, irritation), dysuria, impaired sexual function and quality of life in general. A study of sensations state of women before and after treatment was carried out using the Barlow scale and vaginal health index. All participants were prescribed a topical preparation containing nifuratel and nystatin in vaginal cream as a mototherapy for 8 days. The choice of the nifuratel drug in perimenopausal women is associated with its wide spectrum of its antimicrobial activity and a convenient form of use (cream is the most attractive form with the prevalence of atrophic processes and irritation of the mucous membrane). Antifungal effect of nystatin has an additional therapeutic effect in women with vaginal candidiasis.Study results. Participants showed a significant regression of pathological symptoms and a significant improvement in the life quality after treatment, as evidenced by a significant improvement in the Barlow score by 2.6 times. It should be noted that the positive therapeutic effect persisted for a month after completion of therapy.Conclusions. Based on the study results it can be concluded that the cream containing nifuratel and nystatin is highly clinically effective for treating infectious complications of genitourinary syndrome in perimenopausal women, that makes it possible to recommend this drug in case of such pathological menopausal disorders.

Premature ovarian insufficiency – to treat or not to treat?

Premature ovarian insufficiency (POI) is a rare but very damaging lifestyle condition that occurs at 1–1.5 of women and means termination of menstrual function up to 40 years old. POI impact on women’s wellbeing includes lipid metabolism dysregulation, haemostasis regulation changes, both leading to heart diseases risk increasing, psychological problems, based on early reproductive function termination and anxiety because possible sexual dysfunction, manifestation of pelvic floor disorders. Patients with POI have symptoms, similar to women in menopause, namely vegetative nerve system disorders (hot flashes, night sweats, and emotional lability), insomnia and sexual dysfunction due to vaginal dryness, dyspareunia, and libido loss. It is believed, that estrogen and progesterone deficiency is a leading reason of these complains, but in the same time the role of testosterone decreasing concentration is discussed. Speaking accurately, therapy with exogenous estrogens for women with POI is really replacement, while for patients with normal age menopause it is rather therapy of extension. Nevertheless, only 52% patients with POI have discussed it with their doctors. The article deals with question hormone replacement therapy rationality from the point of view of most popular menopause disorders. Special trials for some of them are published, as for bone mineral density and sexual disorders, treatment for other is possible only by extrapolation from general cohort of menopausal women. For each position questions of effectiveness and safety is discussed. Different ways of estrogen administration are considered, as well as progestin variations. A special attention is paid to possibility of reproductive function restoration in patients with POI. Non-hormonal methods of menopause symptoms correction also discussed – from life style modification to drug administration.

PREVENTION AND TREATMENT OF MENOPAUSAL DISORDERS WITH THE USE OF PHYTOPREPARATIONS

The purpose of our work is to evaluate the clinical manifestations of menopausal disorders in the primary treatment of women and after the proposed complex of non-hormonal treatment. Clinical and laboratory examination of patients of menopausal age was conducted to determine neurovegetative, psycho-emotional, and metabolic-endocrine disorders. The patients were divided into groups as follows: Group I - main, 48 women with physiological menopause up to three years who received a complex of herbal remedies within six months; Group II was a control, 34 women receiving symptomatic treatment for menopausal disorders. The results of the clinical manifestations of climax before and after the use of non-hormonal drugs for six months are presented. Thus, the level of personal anxiety in patients of group I decreased to 30.3 ± 2.8 points (p <0.05), while in group II remained almost at the same level of 40.2 ± 2.5 points (p> 0.05). After the treatment we offered, the percentage of women with climacteric disorders of moderate severity decreased in group I from 54.2% to 18.8%, in II - from 44.1% to 29.4%. The slightly higher rates of physiological menopause in group II women are explained by the fact that patients with severe climax were not included in the treatment group. The effectiveness of this therapy as an alternative method of relief of menopausal manifestations has been established.

PREVENTION AND TREATMENT OF MENOPAUSAL DISORDERS WITH THE USE OF PHYTOPREPARATIONS

The purpose of our work is to evaluate the clinical manifestations of menopausal disorders in the primary treatment of women and after the proposed complex of non-hormonal treatment. Clinical and laboratory examination of patients of menopausal age was conducted to determine neurovegetative, psycho-emotional, and metabolic-endocrine disorders. The patients were divided into groups as follows: Group I - main, 48 women with physiological menopause up to three years who received a complex of herbal remedies within six months; Group II was a control, 34 women receiving symptomatic treatment for menopausal disorders. The results of the clinical manifestations of climax before and after the use of non-hormonal drugs for six months are presented. Thus, the level of personal anxiety in patients of group I decreased to 30.3 ± 2.8 points (p <0.05), while in group II remained almost at the same level of 40.2 ± 2.5 points (p> 0.05). After the treatment we offered, the percentage of women with climacteric disorders of moderate severity decreased in group I from 54.2% to 18.8%, in II - from 44.1% to 29.4%. The slightly higher rates of physiological menopause in group II women are explained by the fact that patients with severe climax were not included in the treatment group. The effectiveness of this therapy as an alternative method of relief of menopausal manifestations has been established.

Severity of menopausal disorders of patients with epilepsy

The results of research testify the negative influence of epilepsy on the severity of menopausal disorders. We conducted a survey of 43 postmenopausal women with epilepsy using climacteric scale of Green. The survey revealed that in presence of epilepsy climacteric syndrome tends to a protracted course with a predominance of severe and moderate forms.

Фитотерапия климактерических нарушений

A study to examine the efficacy and safety of drug Menomedin in patients with climacteric disorders of mild to moderate severity in late reproductive period was performed. The average menopausal index, according to a Menopause Rating Scale (MRS), was significantly lower after treatment (8.6±0.1) than before treatment (23.2±0.5). In all examined women hormone levels corresponded to perimenopausal values. Side effects and individual intolerance reactions were not observed. Antiatherosclerotic effect was detected during treatment Menomedin. Author of the study conclude that a good level of efficacy and safety Menomedin allows to use it at the earliest manifestations of menopausal disorders in women in the late reproductive period (perimenopause). Key words: climacteric syndrome, perimenopause, Menomedin.

Herbal prescription for managing menopausal disorders: A practice survey in Korean medicine doctors

BackgroundThe aim of this study was to investigate the clinical practice of Korean medicine doctors (KMDs) for managing menopausal disorders. MethodsWe conducted a web-based questionnaire for KMDs to respond to recommendations across the three main KM domains: major symptoms of menopausal disorders, herbal prescriptions, and pattern identification. ResultsWe received responses from 227 doctors who have treated menopausal disorders. The major pattern identifications recommended by the doctors for the pre-, peri-, and postmenopausal phases, respectively, were depression of liver energy (59.5%), kidney yin deficiency (49.8%), and kidney yin deficiency (50.7%). The most frequent herbal remedies prescribed for the pre-, peri-, and postmenopausal phases were Jiawei shaoyao-san (58.1%), Jiawei shaoyao-san (48.5%), and Jiawei guipi-decoction (37.9%), respectively. ConclusionThe results of our clinical practice survey provide information on KMDs’ clinical experiences of using herbal medicines and their use of pattern identification to manage menopausal disorders.

VI. Rheumatic Symptoms at the Menopausal Disorder

45～55歳の期間は更年期と呼ばれており，エストロゲン低下が女性特有の多彩な症状をもたらす．その症状に加え，朝のこわばり，手指の疼痛ならびに乾燥感があると，関節リウマチやSjögren症候群ではないかと心配し，内科医を訪れる患者が多い．関節の腫脹がなく，CRPの上昇がなければ，関節リウマチの可能性は少ないが，リウマチ反応がみられ，抗CCP抗体及び抗核抗体が陽性である場合は，適切な対応が必要である．閉経後であれば，ホルモン補充療法が有効であることが多い．

Traditional Medicine (Mahuang-Tang) Improves Ovarian Dysfunction and the Regulation of Steroidogenic Genes in Letrozole-Induced PCOS Rats.

Mahuang-Tang (MHT) has traditionally been used in Asia to treat a variety of diseases, such as fever without sweating, joint pain, lower back pain, asthma, and gynecological conditions. Polycystic ovary syndrome (PCOS) is a kind of gynecological disease that causes amenorrhea, infertility, and menopausal and urogenital disorders that could benefit from MHT treatment. In this study, we examined the effects of MHT on ovarian hormones and steroidogenic enzymes in female PCOS rats. The PCOS rat model was induced by Letrozole, and an in vivo evaluation of whether the dietary consumption of MHT improved the PCOS-like symptoms was conducted. The luteinizing hormone (LH) level and luteinizing hormone/follicular-stimulating hormone (LH/FSH) ratio increased in PCOS rats but decreased following MHT treatment. In the PCOS rats, the reduced estrogen level was restored to that of normal controls with MHT treatment in serum. The transcription level(s) of gonadotropin receptors (Fshr and Lhr), steroid receptors (Pgr, and Esr1) and steroidogenic enzymes (Cyp19a1, Hsd3b1, Hsd17a1, and Cyp11a1) changed under the PCOS condition, and were regulated by MHT treatment in the ovaries of PCOS rats. The reproductive tissues of Letrozole-induced PCOS rats were restored into estrogenic condition from androgen environments. These results suggest that MHT ameliorates the symptoms of PCOS by improving the dysregulation of ovarian steroids and steroidogenic enzymes in PCOS rats.

Alternative therapies for menopausal disorders

A woman’s life can be theoretically divided into certain periods: children’s, adolescent, reproductive and ageing. The latter is also called menopause. Everything related to ageing is usually associated with negative expectations and a pessimistic disposition. But if it is remembered, the word «climax» comes from the Greek language, meaning «staircase». Thus, menopause presents a culmination of a «female career». Each period is marked by its physiological characteristics, and menopause is no exception. The completion of the reproductive system functioning is often accompanied by the formation of a number of estrogen-deficient conditions. The latest modern insights, ranging from hormonal substances to alternative compounds, can effectively solve the problems of menopause.

Hypertension and menopause

The climacteric period (menopause) is one of the most important periods in a woman’s life, reflecting the natural extinction of the reproductive function. Current hormonal changes and developing menopausal disorders initiate the formation of pathological conditions that have a negative impact on both the health and expectancy of life and its quality. Cardiovascular diseases are one of the most common pathological conditions. Arterial hypertension (AH) is a key risk factor for the development of cardiovascular diseases, in different periods of menopause has various clinical and pathogenetic features that must be considered during treatment. Indapamide have pronounced antihypertensive effect, organ-protective properties and metabolic neutrality. It is drug of choice for mono- or combination therapy for women with hypertension during different periods of menopause. Effective antihypertensive and organ-protective action, metabolic neutrality and safety of nitrendipine use allow us to recommend this drug for combination therapy of hypertension in women in distant menopause. The combination of indapamide and nitrendipine may be one of the most effective tools for hypertension treating in women in distant climacteric period.

Forecasting and prevention of complication of menopausal hormonal therapy

In modern conditions, the peak of professional activity of many women falls precisely during the period of perimenopause. Therefore, maintaining physical fitness, beauty, health, sexuality, femininity, learning ability, self-improvement and interest in life is very important during this period. Menopausal hormone therapy (MHT) is prescribed for the prevention and elimination of menopausal disorders. It is very important to differentiate the selection of IHT, taking into account the state of health of the woman and the study of concomitant pathology, as well as the modes of its appointment. An individualized approach to the administration of MHT will help to maximize its therapeutic and prophylactic potential, reducing the number of adverse reactions and complications. The aim is to examine the relationship between anamnestic data (obstetric and gynecological and somatic status) and the risk of complications from menopausal hormone therapy. The authors conducted a survey on a specially designed questionnaire of 178 perimenopausal women: had some complications on the background of its use and 80 women of the same age who had no complications from MHT — the control group. During the study, the chances of the occurrence of a particular pathology in women were calculated on the background of taking MHT in the presence of various diseases. It was found that in patients with a history of PMS, DMZ, migraine, unstable blood pressure, overweight, gynecological diseases, namely inflammatory diseases, uterine fibroids, endometriosis, varicose veins, swelling, transmitted diseases the risk of developing complications from MHT is much higher than that in healthy women, which allows them to be put at risk. These complications can be minimized by choosing the optimal treatment regimen, and the benefits of using it can be maximized by taking into account the relationships found. Taking into account the identified links between the studied factors will prevent complications from the use of MHT in each individual woman at the stage of MHT selection and will allow to isolate such patients in the risk group of development or will allow to predict the occurrence of one or another disease depending on the presence of a disease.